Access to EHR Notes Lauded by Patients, Providers

In a pilot, a system which permits patients to view all the notes in their electronic health records was such a hit with hospital patients and physicians that Beth Israel Deaconess Medical Center and Geisinger Health System are dramatically expanding their OpenNotes programs.

Possibly the most famous consumer of electronic health records is Dave deBronkart, better known as e-Patient Dave.

Several years ago, deBronkart participated in a trial of a new program that permitted patients to view all the notes in their EHR.

"I experienced a direct benefit," deBronkart recalls. "Weeks after a visit, I thought, 'Wasn't I supposed to have something followed up?' Heaven knows where my printed visit notes were … it was late in the evening, so ordinarily I'd have waited till morning and maybe remembered to call in and have someone look it up—very inefficient and vulnerable to 'I forgot.'

"Instead, I went online right then and there, just as you might with anything else, from airline reservations to credit card info. There it was: actinic keratosis—a precancerous lesion. I had it removed, quickly, easily, inexpensively." deBronkart says the diagnosis was "not academic" for him. "Thirty years earlier I had a skin cancer removed from my nose. And about a year later I was found to have a new one on my jaw.

"As a guy who worked in technology all his life," deBronkart says, "it's clear to me that what's happening here is that value in healthcare depends on information plus awareness. In that moment I was aware of the information, which enabled action."

Now deBronkart's OpenNotes experience is being deployed at scale, and healthcare will never be the same.

The OpenNotes movement was tested for 12 months at three institutions: Beth Israel Deaconess Medical Center (649 licensed beds), Geisinger Health System (1,363 licensed beds), and the 413-bed Harborview Medical Center, a safety-net hospital that is part of the UW Medicine system in Seattle. Results from the study were published in the October 2012 Annals of Internal Medicine.

At the end of the tests, providers and patients liked OpenNotes so much that for those patients, access to those notes was restored after the trial. This year, Beth Israel and Geisinger are both dramatically expanding their OpenNotes programs.